Q:

What is an HMO doctor?

A:

Quick Answer

An HMO doctor is a doctor who has a contract to provide care through one or more HMO insurance plans. Patients with HMO plans can only receive coverage for care provided by doctors contracted by their specific plans.

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Full Answer

An HMO (Health Maintenance Organization) is a health insurance plan that requires its members to obtain care from members of the HMO's own network of facilities and providers.

Most HMOs require patients to select a primary care physician who provides most needed care and refers patients to other providers when it is necessary. HMOs usually require patients to obtain referrals from their primary care physicians in order to receive care from a specialist. HMOs also have networks of contracted group practices, hospitals and labs. People who have HMO plans are normally required to obtain all of their care from within the HMO network, with exceptions for emergencies and for urgent issues that occur when a patient is outside of the network's geographical area.

While HMOs limit flexibility in terms of the providers patients can see, they are sometimes more affordable than other types of health insurance plans. HMOs often require fixed co-payments for services, rather than a percentage of the total cost.

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